Abstract
What is the study about?
From 2022, 42 Integrated Care Systems (ICS) are responsible for organizing and delivering integrated care in England. The aim of ICSs is to improve the coordination of care for patients and service users, especially across organisational boundaries. They offer ‘horizontal’ system level integration bringing together previously siloed organizations (including National Health Service, public health, social and community care, and the voluntary sector).
To understand the usefulness of integration, it needs to be systematically and comprehensively evaluated. But to date there is limited understanding of how to assess the benefits of integration and the effectiveness of ICSs. Our study seeks to address this by using the Core Outcome Set (COS) method to elicit stakeholders and build consensus on what outcomes describe quality in ICSs and how to assess these outcomes.
Who is it for?
The study is targeted at ICSs in England. However, the findings will be valuable for those aiming to evaluate ‘horizontal’ system level integration and those providing it.
Who will be involved in the study?
Diverse health and social care stakeholders, including people using health and care services; health and social care staff; ICS managers; policymakers and arms-length bodies (eg the Care Quality Commission); and community and voluntary services. The study is supported throughout by three patient and public (PPI) advisors.
What will we do?
The COS methodology was initially developed for clinical trials but is increasingly used for routine care. Our study will explore the feasibility of developing a COS for ‘horizontal’ system level integrated care by scoping issues and developing an appropriate and robust methodological approach. Next, the study will develop a patient or service user-oriented COS. This will involve identifying (through literature reviews) and gaining consensus (through stakeholder consultation) on 1) what needs to be measured, and 2) which instruments or tools to use (how to measure).
What progress have we made?
Work on scoping the issues and identifying solutions has been concluded. One issue, for example, is that ICSs take a population health-based approach. This is a challenge due to the wealth of applicable literature and the risk of not achieving stakeholder consensus. As integrated care is expected to be particularly beneficial to an ageing and chronic disease population, we will focus on people with chronic long-term and/or complex conditions.
Broadly, there is evidence from a potentially substantial body of literature on how to assess outcomes for chronic conditions. Existing COS on chronic conditions are likely to be valuable for identifying what dimensions to measure. However, this approach may fail to identify ‘integration’ as a dimension and literature on integration is likely to be more limited. Therefore, in addition to literature reviews we will seek input from experts and policy makers on what they think is important to measure when assessing the benefits of integration and how to overcome challenges. This would allow us to compare the views of experts with the literature and to adjust our approach, if necessary, to ensure our findings have applicability beyond England’s ICSs.